TY - JOUR
T1 - Real-world performance of SARS-Cov-2 serology tests in the United States, 2020
AU - Rodriguez-Watson, Carla V.
AU - Louder, Anthony M.
AU - Kabelac, Carly
AU - Frederick, Christopher M.
AU - Sheils, Natalie E.
AU - Eldridge, Elizabeth
AU - Lin, Nancy D.
AU - Pollock, Benjamin D.
AU - Gatz, Jennifer L.
AU - Grannis, Shaun J.
AU - Vashisht, Rohit
AU - Ghauri, Kanwal
AU - Knepper, Camille
AU - Leonard, Sandy
AU - Embi, Peter J.
AU - Jenkinson, Garrett
AU - Klesh, Reyna
AU - Garner, Omai B.
AU - Patel, Ayan
AU - Dahm, Lisa
AU - Barin, Aiden
AU - Cooper, Dan M.
AU - Andriola, Tom
AU - Byington, Carrie L.
AU - Crews, Bridgit O.
AU - Butte, Atul J.
AU - Allen, Jeff
N1 - Funding Information:
Financial support for this work was provided in part by a grant from The Rockefeller Foundation (HTH 030 GA-S). BDP, CK, GJ used funding provided by Yale University-Mayo Clinic Center of Excellence in Regulatory Science and Innovation (CERSI), a joint effort between Yale University, Mayo Clinic, and the U.S. Food and Drug Administration (FDA) (3U01FD005938) (https://www.fda.gov/). AJB was funded by award number A128219 and Grant Number U01FD005978 from the FDA, which supports the UCSF-Stanford Center of Excellence in Regulatory Sciences and Innovation (CERSI). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the HHS or FDA. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Special thanks to our advisors on this project from the U.S. Food and Drug Administration: Aloka Chakravarty, Tamar Lasky, Gina Valo, Mary Jung, Stephen Lovell, Jacqueline M Major, Daniel Caños, Sara Brenner, and Wendy Rubinstein; and Duke-Margolis: Christina Silcox. We thank all members of the Evidence Accelerator Workgroup for their support and feedback: Roland Romero, James Okusa, Elijah Mari Quinicot, Amar Bhat, Susan Winckler, Alecia Clary, Sadiqa Mahmood, Philip Ballentine, Perry L. Mar, Cynthia Lim Louis, Connor McAndrews, Elitza S. Theel, Cora Han, Pagan Morris, and Charles Wilson. A special thanks and recognition for the contributions and sacrifice of Dr. Michael Waters, our dear colleague, and friend who will be forever in our thoughts. We thank Amir Alishahi Tabriz MD, PhD for his assistance with manuscript preparation.
Publisher Copyright:
© 2023 Watson et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
PY - 2023/2
Y1 - 2023/2
N2 - Background Real-world performance of COVID-19 diagnostic tests under Emergency Use Authorization (EUA) must be assessed. We describe overall trends in the performance of serology tests in the context of real-world implementation. Methods Six health systems estimated the odds of seropositivity and positive percent agreement (PPA) of serology test among people with confirmed SARS-CoV-2 infection by molecular test. In each dataset, we present the odds ratio and PPA, overall and by key clinical, demographic, and practice parameters. Results A total of 15,615 people were observed to have at least one serology test 14–90 days after a positive molecular test for SARS-CoV-2. We observed higher PPA in Hispanic (PPA range: 79–96%) compared to non-Hispanic (60–89%) patients; in those presenting with at least one COVID-19 related symptom (69–93%) as compared to no such symptoms (63–91%); and in inpatient (70–97%) and emergency department (93–99%) compared to outpatient (63–92%) settings across datasets. PPA was highest in those with diabetes (75–94%) and kidney disease (83–95%); and lowest in those with auto-immune conditions or who are immunocompromised (56–93%). The odds ratios (OR) for seropositivity were higher in Hispanics compared to non-Hispanics (OR range: 2.59–3.86), patients with diabetes (1.49–1.56), and obesity (1.63–2.23); and lower in those with immunocompromised or autoimmune conditions (0.25–0.70), as compared to those without those comorbidities. In a subset of three datasets with robust information on serology test name, seven tests were used, two of which were used in multiple settings and met the EUA requirement of PPA ≥87%. Tests performed similarly across datasets. Conclusion Although the EUA requirement was not consistently met, more investigation is needed to understand how serology and molecular tests are used, including indication and protocol fidelity. Improved data interoperability of test and clinical/demographic data are needed to enable rapid assessment of the real-world performance of in vitro diagnostic tests.
AB - Background Real-world performance of COVID-19 diagnostic tests under Emergency Use Authorization (EUA) must be assessed. We describe overall trends in the performance of serology tests in the context of real-world implementation. Methods Six health systems estimated the odds of seropositivity and positive percent agreement (PPA) of serology test among people with confirmed SARS-CoV-2 infection by molecular test. In each dataset, we present the odds ratio and PPA, overall and by key clinical, demographic, and practice parameters. Results A total of 15,615 people were observed to have at least one serology test 14–90 days after a positive molecular test for SARS-CoV-2. We observed higher PPA in Hispanic (PPA range: 79–96%) compared to non-Hispanic (60–89%) patients; in those presenting with at least one COVID-19 related symptom (69–93%) as compared to no such symptoms (63–91%); and in inpatient (70–97%) and emergency department (93–99%) compared to outpatient (63–92%) settings across datasets. PPA was highest in those with diabetes (75–94%) and kidney disease (83–95%); and lowest in those with auto-immune conditions or who are immunocompromised (56–93%). The odds ratios (OR) for seropositivity were higher in Hispanics compared to non-Hispanics (OR range: 2.59–3.86), patients with diabetes (1.49–1.56), and obesity (1.63–2.23); and lower in those with immunocompromised or autoimmune conditions (0.25–0.70), as compared to those without those comorbidities. In a subset of three datasets with robust information on serology test name, seven tests were used, two of which were used in multiple settings and met the EUA requirement of PPA ≥87%. Tests performed similarly across datasets. Conclusion Although the EUA requirement was not consistently met, more investigation is needed to understand how serology and molecular tests are used, including indication and protocol fidelity. Improved data interoperability of test and clinical/demographic data are needed to enable rapid assessment of the real-world performance of in vitro diagnostic tests.
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U2 - 10.1371/journal.pone.0279956
DO - 10.1371/journal.pone.0279956
M3 - Article
C2 - 36735683
AN - SCOPUS:85147458250
SN - 1932-6203
VL - 18
JO - PLoS One
JF - PLoS One
IS - 2 February
M1 - e0279956
ER -